Inpatient Stay Sample Clauses

Inpatient Stay. A period of uninterrupted Inpatient confinement that begins with formal admission and ends upon discharge. An Inpatient Stay may include a Medically Necessary transfer from one Hospital to another Hospital as an Inpatient. Maine Health Insurance Marketplace. A mechanism intended to provide a transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Also known as the Maine Marketplace or Marketplace.
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Inpatient Stay. A period of uninterrupted Inpatient confinement that begins with formal admission and ends upon discharge. An Inpatient Stay may include a Medically Necessary transfer from one Hospital to another Hospital as an Inpatient. Maintenance Medications. A prescription drug that is prescribed to you by your Provider for treatment of a long-term condition or illness (e.g., blood pressure medication, cholesterol medication). Medications that are prescribed to treat short-term conditions (e.g., antibiotics) are not considered Maintenance Medications. Maintenance Therapy. Any service, procedure, treatment, or therapy that has the primary purpose of preserving the present level of function and prevents deterioration of that function, as opposed to improving a function (within a reasonable timeframe established in a plan of care) to an extent that may allow for a more independent existence. Maintenance Therapy occurs when the condition of the patient receiving the service, procedure, treatment, or therapy does not or is not expected to materially improve within a reasonable timeframe established in a plan of care, or when the goals of a treatment plan have been met. Marketplace. In Maine, the Federally Facilitated Marketplace. Maximum Allowable Amount or Maximum Allowance. The maximum amount that a Member and Health Options will pay a Network Provider for a Covered Service. The Maximum Allowable Amount or Maximum Allowance equals the Usual, Customary, and Reasonable Charge for a Covered Service.
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Inpatient Stay. Source and dates of related inpatient stay (if applicable).
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Inpatient Stay. During Your Surgery Total joint replacement surgery takes approximately 1 to 2 hours. The type of anesthesia that will be used will be discussed with you before the procedure by an anesthesiologist. After Your Surgery (Post-operative) POST-ANESTHESIA CARE UNIT: RECOVERY ROOM Common symptoms that happen after surgery: • Blurry vision • Dry mouth • Chills • Pain/Discomfort • Sore throat Nursing staff will be monitoring your blood pressure, pulse, and breathing very closely during this phase of your joint replacement. Sometimes people require a little bit of oxygen which is normal. Let nursing staff know if you have pain or nausea. Medications are available to ease your discomfort. After surgery you will be transferred to the orthopaedic floor. Visitors and guests will be given your location information.
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Inpatient Stay. When you arrive on the inpatient unit: Your nurse will order you a clear liquid tray and give you some saltine crackers. We encourage you to try to eat something because pain medications can cause nausea on an empty stomach. • Scopolamine Patch: Your doctor may have this patch placed behind your ear before surgery. If so, the patch will remain in place for 3 days. • Zofran (ondansetron): Usually given during surgery and as needed after surgery. Side effects are limited but may include headache. Blood Clots Prevention Having a total joint replacement puts you at risk for blood clots. Things will be done during your hospital stay and at home to prevent blood clots. DEEP VEIN THROMBOSIS (DVT) This condition is a blood clot that forms in a vein deep inside the body. This type of clot most commonly develops in the legs. This condition is dangerous, because the clot can break free and travel through the bloodstream to the lungs, called a pulmonary embolism. PULMONARY EMBOLISM (PE) A serious complication of deep vein thrombosis is called pulmonary embolism. This occurs when the clot breaks free, travels through the bloodstream and lodges within one of the pulmonary vessels. These are the arteries that supply blood to the lungs. Prevention includes: • Move, move, move—as soon as possible! • When lying in bed, pump your feet up and down to get blood that is pooling in your legs back to your heart. • Get out of bed and start walking as soon as possible. Challenge yourself to get out of bed for all meals and to walk at least 3 times a day. Patient Guide for Total Hip and Total Knee Replacement Surgery 13 SEQUENTIAL COMPRESSION DEVICE (SCDS) These devices wrap around the calf of your legs and fill with air. They will be applied during your surgery to prevent blood from pooling in your legs. This will decrease your risk of blood clots. These are to be on whenever you are in bed or in a chair. For best results we encourage you to keep them on for at least 18 hours per day. BLOOD THINNING MEDICATIONS Starting after surgery you will take a blood thinner to help prevent blood clots. Your doctor will decide which blood thinner you will be on. You can expect to be on a blood thinner for up to one month following your surgery.
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Inpatient Stay. Decreased activity and pain medications slow down your bowels and therefore constipation can happen very quickly. To prevent constipation you will be given stool softeners during your hospital stay. A few include: Dulcolax, Bisacodyl, Pericolace and Miralax. You can reduce your chances of constipation by: • Eating a diet that is full of fiber • Drinking plenty of fluids during the day • Increasing activity: walk, walk, walk • Going to the bathroom at regular times every day Department of Orthopaedic Surgery
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Inpatient Stay. Prevent Falls During your hospital stay and when you are at home it is VERY important to prevent falls to protect your new joint. After surgery you are at an increased risk for falling. Factors that put you at risk: • Unsteady walking • Pain medications • Different environment IN THE HOSPITAL
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Inpatient Stay. 4. Breathe in slowly and as deeply as possible. Notice the yellow piston rising toward the top of the column. The yellow indicator should reach the blue outlined area.
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Inpatient Stay. A period of uninterrupted Inpatient confinement that begins with formal admission and ends upon discharge. An Inpatient Stay may include a Medically Necessary transfer from one Hospital to another Hospital as an Inpatient. SAMPLE Maintenance Medications . A prescription drug that is prescribed to you by your Provider for treatment of a long - term condition or illness (e.g., blood pressure medication, cholesterol medication). Medications that are prescribed to treat short - term co nditions (e.g., antibiotics) are not considered Maintenance Medications. Maintenance Therapy . Any service, procedure, treatment, or therapy that has the primary purpose of preserving the present level of function and prevents deterioration of that functio n, as opposed to improving a function (within a reasonable timeframe established in a plan of care) to an extent that may allow for a more independent existence. Maintenance Therapy occurs when the condition of the patient receiving the service, procedure , treatment, or therapy does not or is not expected to materially improve within a reasonable timeframe established in a plan of care, or when the goals of a treatment plan have been met. Marketplace . In Maine, the Federally Facilitated Marketplace. Maxi mum Allowable Amount or Maximum Allowance . The maximum amount that a Member and Health Options will pay a Network Provider for a Covered Service. The Maximum Allowable Amount or Maximum Allowance equals the Usual, Customary, and Reasonable Charge for a C overed Service.
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Related to Inpatient Stay

  • Inpatient In accordance with Rhode Island General Law §27-20-17.1, this agreement covers a minimum inpatient hospital stay of forty- eight (48) hours from the time of a vaginal delivery and ninety-six (96) hours from the time of a cesarean delivery: • If the delivery occurs in a hospital, the hospital length of stay for the mother or newborn child begins at the time of delivery (or in the case of multiple births, at the time of the last delivery). • If the delivery occurs outside a hospital, the hospital length of stay begins at the time the mother or newborn is admitted as a hospital in connection with childbirth. Any decision to shorten these stays shall be made by the attending physician in consultation with and upon agreement with you. In those instances where you and your infant participate in an early discharge, you will be eligible for: • up to two (2) home care visits by a skilled, specially trained registered nurse for you and/or your infant, (any additional visits must be reviewed for medical necessity); and • a pediatric office visit within twenty-four (24) hours after discharge. See Section 3.23 - Office Visits for coverage of home and office visits. We cover hospital services provided to you and your newborn child. Your newborn child is covered for services required to treat injury or sickness. This includes the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities as well as routine well-baby care.

  • Outpatient If you receive dialysis services in a hospital's outpatient unit or in a dialysis facility, we cover the use of the treatment room, related supplies, solutions, drugs, and the use of the dialysis machine. In Your Home If you receive dialysis services in your home and the services are under the supervision of a hospital or outpatient facility dialysis program, we cover the purchase or rental (whichever is less, but never to exceed our allowance for purchase) of the dialysis machine, related supplies, solutions, drugs, and necessary installation costs. Related Exclusions If you receive dialysis services in your home, this agreement does NOT cover: • installing or modifying of electric power, water and sanitary disposal or charges for these services; • moving expenses for relocating the machine; • installation expenses not necessary to operate the machine; or • training you or members of your family in the operation of the machine. This agreement does NOT cover dialysis services when received in a doctor's office.

  • Inpatient Services Hospital This plan covers services provided while inpatient in a general or specialty hospital including, but not limited to the following: • anesthesia; • diagnostic tests and lab services; • dialysis; • drugs; • intensive care/coronary care; • nursing care; • physical, occupational, speech and respiratory therapies; • physician’s services while hospitalized; • radiation therapy; • surgery related services; and • room and board. Notify us if you are admitted from the emergency room to a hospital that is not in our network. Our Customer Service Department can assist you with any questions you may have about your coverage. Rehabilitation Facility This plan covers rehabilitation services received in a general hospital or specialty hospital. Coverage is limited to the number of days shown in the Summary of Medical Benefits.

  • Outpatient Dental Anesthesia Services This plan covers anesthesia services received in connection with a dental service when provided in a hospital or freestanding ambulatory surgical center and: • the use of this is medically necessary; and • the setting in which the service is received is determined to be appropriate. This plan also covers facility fees associated with these services.

  • Preventive Care This plan covers preventive care as described below. “

  • Durable Medical Equipment (DME), Medical Supplies, Prosthetic Devices, Enteral Formula or Food, and Hair Prosthesis (Wigs) This plan covers durable medical equipment and supplies, prosthetic devices and enteral formula or food as described in this section. Durable Medical Equipment (DME) DME is equipment which: • can withstand repeated use; • is primarily and customarily used to serve a medical purpose; • is not useful to a person in the absence of an illness or injury; and • is for use in the home. DME includes supplies necessary for the effective use of the equipment. This plan covers the following DME: • wheelchairs, hospital beds, and other DME items used only for medical treatment; and • replacement of purchased equipment which is needed due to a change in your medical condition or if the device is not functional, no longer under warranty, or cannot be repaired. DME may be classified as a rental item or a purchased item. In most cases, this plan only pays for a rental DME up to our allowance for a purchased DME. Repairs and supplies for rental DME are included in the rental allowance. Preauthorization may be required for certain DME and replacement or repairs of DME. Medical Supplies Medical supplies are consumable supplies that are disposable and not intended for re- use. Medical supplies require an order by a physician and must be essential for the care or treatment of an illness, injury, or congenital defect. Covered medical supplies include: • essential accessories such as hoses, tubes and mouthpieces for use with medically necessary DME (these accessories are included as part of the rental allowance for rented DME); • catheters, colostomy and ileostomy supplies, irrigation trays and surgical dressings; and • respiratory therapy equipment. Diabetic Equipment and Supplies This plan covers diabetic equipment and supplies for the treatment of diabetes in accordance with R.I. General Law §27-20-30. Covered diabetic equipment and supplies include: • therapeutic or molded shoes and inserts for custom-molded shoes for the prevention of amputation; • blood glucose monitors including those with special features for the legally blind, external insulin infusion pumps and accessories, insulin infusion devices and injection aids; and • lancets and test strips for glucose monitors including those with special features for the legally blind, and infusion sets for external insulin pumps. The amount you pay differs based on whether the equipment and supplies are bought from a durable medical equipment provider or from a pharmacy. See the Summary of Pharmacy Benefits and the Summary of Medical Benefits for details. Coverage for some diabetic equipment and supplies may only be available from either a DME provider or from a pharmacy. Visit our website to determine if this is applicable or call our Customer Service Department. Prosthetic Devices Prosthetic devices replace or substitute all or part of an internal body part, including contiguous tissue, or replace all or part of the function of a permanently inoperative or malfunctioning body part and alleviate functional loss or impairment due to an illness, injury or congenital defect. Prosthetic devices do not include dental prosthetics. This plan covers the following prosthetic devices as required under R.I. General Law § 27-20-52: • prosthetic appliances such as artificial limbs, breasts, larynxes and eyes; • replacement or adjustment of prosthetic appliances if there is a change in your medical condition or if the device is not functional, no longer under warranty and cannot be repaired; • devices, accessories, batteries and supplies necessary for prosthetic devices; • orthopedic braces except corrective shoes and orthotic devices used in connection with footwear; and • breast prosthesis following a mastectomy, in accordance with the Women’s Health and Cancer Rights Act of 1998 and R.I. General Law 27-20-29. The prosthetic device must be ordered or provided by a physician, or by a provider under the direction of a physician. When you are prescribed a prosthetic device as an inpatient and it is billed by a provider other than the hospital where you are an inpatient, the outpatient benefit limit will apply. Enteral Formulas or Food (Enteral Nutrition) Enteral formula or food is nutrition that is absorbed through the intestinal tract, whether delivered through a feeding tube or taken orally. Enteral nutrition is covered when it is the sole source of nutrition and prescribed by the physician for home use. In accordance with R.I. General Law §27-20-56, this plan covers enteral formula taken orally for the treatment of: • malabsorption caused by Crohn’s Disease; • ulcerative colitis; • gastroesophageal reflux; • chronic intestinal pseudo obstruction; and • inherited diseases of amino acids and organic acids. Food products modified to be low protein are covered for the treatment of inherited diseases of amino acids and organic acids. Preauthorization may be required. The amount that you pay may differ depending on whether the nutrition is delivered through a feeding tube or taken orally. When enteral formula is delivered through a feeding tube, associated supplies are also covered. Hair Prosthesis (Wigs) This plan covers hair prosthetics (wigs) worn for hair loss suffered as a result of cancer treatment in accordance with R.I. General Law § 27-20-54 and subject to the benefit limit and copayment listed in the Summary of Medical Benefits. This plan will reimburse the lesser of the provider’s charge or the benefit limit shown in the Summary of Medical Benefits. If the provider’s charge is more than the benefit limit, you are responsible for paying any difference. Early Intervention Services (EIS) This plan covers Early Intervention Services in accordance with R.I. General Law §27- 20-50. Early Intervention Services are educational, developmental, health, and social services provided to children from birth to thirty-six (36) months. The child must be certified by the Rhode Island Department of Human Services (DHS) to enroll in an approved Early Intervention Services program. Services must be provided by a licensed Early Intervention provider and rendered to a Rhode Island resident. Members not living in Rhode Island may seek services from the state in which they reside; however, those services are not covered under this plan. Early Intervention Services as defined by DHS include but are not limited to the following: • speech and language therapy; • physical and occupational therapy; • evaluation; • case management; • nutrition; • service plan development and review; • nursing services; and • assistive technology services and devices.

  • Cardiac Rehabilitation This plan covers services provided in a cardiac rehabilitation program up to the benefit limit shown in the Summary of Medical Benefits.

  • Outpatient Services The following services are covered only at the Primary Care Provider’s office[selected by a [Member], or elsewhere [upon prior written Referral by a [Member]'s Primary Care Provider ]:

  • Skilled Care in a Nursing Facility This plan covers skilled nursing services in a skilled nursing facility if: • the services are prescribed by a physician: • your condition needs skilled nursing services, skilled rehabilitation services or skilled nursing observation; • the services are provided by or supervised by licensed technical or professional medical personnel; and • the services are not custodial care, respite care, day care, or for the purpose of assisting with activities of daily living.

  • Hospital This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. Residential Treatment Facility This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. Intermediate Care Services This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

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